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Social Welfare Services JST Application form for Data Classification R Jobseeker’s Transitional Payment What is Jobseeker’s Transitional Payment? The Jobseeker’s Transitional Payment (JST) is a special arrangement under the Jobseeker’s Allowance Scheme It helps lone parents with young children aged between to 13 years inclusive go back to work If you are no longer entitled to One-Parent Family Payment and your youngest child is 14 years or older, you can apply for Jobseeker’s Allowance How I qualify? You will qualify for Jobseeker’s Transitional Payment if: • Your youngest child between and 13 years of age inclusive; • You are a lone parent; and • You are not cohabiting You not have to be available for and genuinely seeking full-time work This is to allow you to meet your caring responsibilities when you have young children Childcare supports are available if you find work You can also: • Take part in a course of study or education and get Jobseeker’s Transitional Payment (JST) If you are eligible, you may also get a student maintenance grant from SUSI – Student Universal Support Ireland • Work part-time five days a week and still get JST, subject to the means test This will allow you to work mornings only while your child or children are in school How to Apply? Complete this application form and return it to your local Intreo Centre or Social Welfare Branch Office For details on your local office visit www.gov.ie/intreo How to complete this application form • You need a Personal Public Service (PPS) Number before you apply • There is an example on the back of this page that can be used as a guide to fill in this form • Write with a black ballpoint pen, use capital letters and place an X in relevant boxes • In Parts to 6, please answer all questions that apply to you • Please leave boxes blank if they not apply to you, • When the form is completed, read Part and sign the declaration in Part If you need any help to complete this form, please contact your local Citizens Information Centre, your local Intreo Centre, or your local Social Welfare Branch Office For more information, please visit www.gov.ie/jst How to fill this form To help us to process your application write letters and numbers clearly and use one box for each Please see examples below Your own details Part 1 Your PPS Number: T Title, insert an X or specify: Mr Mrs X Ms Other Surname: M U R P H Y First names: M A U R E E N Your first name as it appears on your birth certificate: M A R Y Birth surname: K E L L Y Your date of birth: D D M M Y Y Y Y M C D E R M O T T Your address: Contact Details N E W O L D S T R E E T T O W N D O N E G A L County D O N E G A L Eircode A F E T O W N Your telephone number: 8 10. Your email address: M M U R P H Y @ W E L F A R E I E SAMPLE Social Welfare Services JST Application form for Data Classification R Jobseeker’s Transitional Payment Your own details Part 1 Your PPS Number: Title, insert an X or specify: Mr Mrs Other Ms Surname: First names: Your first name as it appears on your birth certificate: Birth surname: Your date of birth: D D M M Y Y Y Y Contact Details Your address: County Eircode Your telephone number: 10 Your email address: Declaration I declare that the information given by me on this form is truthful and complete I understand that if any of the information I provide is untrue or misleading or if I fail to disclose any relevant information, that I will be required to repay any payment I receive from the department and that I may be prosecuted I undertake to immediately advise the department of any change in my circumstances which may affect my continued entitlement Date: D D M M Y Y Y Y Signature, not capital letters Warning: If you make a false statement or withhold information, you may be prosecuted leading Page to a3 fine, a prison term or both Part continued Your own details 11 Are you? Single Cohabiting Married In a Civil Partnership Separated A surviving Civil Partner Divorced A former Civil Partner (you were in a Civil Partnership that has since been dissolved) Widowed 11a If you are married, in a civil partnership, a civil union or cohabiting, from what date? D D M M Y Y Y Y Please attach your marriage certificate, civil partnership or civil union registration certificate if you married or entered into a civil partnership or civil union outside of Ireland We not accept photocopies 11b If you are divorced, had a civil partnership dissolved or are no longer cohabiting, from what date? D D M M Y Y Y Y Please attach your Decree Absolute Certificate or Decree of Dissociation We not accept photocopies 11c If you are widowed, are a surviving civil partner or your cohabitant died, from what date? D D M M Y Y Y Y Please attach your late spouse’s, civil partner’s or cohabitant’s original death certificate A coroner’s report is also acceptable We not accept photocopies Page Part Your work and claim details 12 Are you employed at present, including part-time or temporary work? Yes If yes, please state: Your occupation: Employer’s name: Employer’s address: No County Eircode Your weekly gross pay: € , Gross Pay is your pay before tax, PRSI, union dues or other deductions Please attach three recent payslips 13 Are you self-employed at present? Yes If yes, please state: Your occupation: Your weekly gross pay: € , No Please attach your most recent set of accounts 14 Are you getting any payment from this department? Yes If yes, please state: Name of payment: Weekly Amount: € , No Page Your Yourwork workand andclaim claimdetails details Part continued Part continued 15 Is anyone claiming an increase for you as a dependant on their Social Protection payment? If yes, please state: Their name: Yes No Their address: County Eircode Name of payment: 16 Are you receiving maintenance? Yes If yes, please state: Weekly amount: € , No Please provide a copy of the maintenance agreement 17 Are you paying maintenance? Yes No If yes, please state: Weekly amount: € , Please provide a copy of the maintenance agreement 18 If you are not getting maintenance, what efforts are you taking to get maintenance? 19 Does the other parent of your children pay towards the rent or mortgage costs of your current accommodation? Yes No If yes, please state: Weekly amount: € , Page Part continued Your work and claim details 20 Do you own the property you currently live in? Yes No If yes, please state: Mortgage repayment: € , a month 21 Do you rent the property you currently live in? Yes If yes, please state: € Rent you pay: , No a month 22 Do you own or share in the ownership of any other property apart from your home? Yes No If yes, please state: Type of Property: Address of Property: Property that is an apartment, business property, another house or land other than that mentioned at question 20 Current market value: € , , Rent from this property: € , Please provide current documentary evidence of market value or rental income from property If mortgaged please attach a recent statement from lending institution Page Part continued Yourwork workand andclaim claimdetails details Your 23 Do you have savings or accounts in a bank, post office, building society, credit union or any other financial institution in the Republic of Ireland or another country? Yes If yes, please state: No Financial Institution Name of financial institution: Bank Identifier Code (BIC): International Bank Account Number (IBAN): Current balance: € Is this account a joint account? , Yes No Names of account holders: Name 1: Name 2, if any: Financial Institution Name of financial institution: Bank Identifier Code (BIC): International Bank Account Number (IBAN): Current balance: Is this account a joint account? , € Yes No Names of account holders: Name 1: Name 2, if any: Please attach an original statement for each account, showing transactions for the last three months Page If you have any other accounts you must give details of them to this department on a separate sheet of paper Part continued Your work and claim details 24 Do you own stocks, shares including shares in a creamery or Co-op, annuities, bonds, insurance policies or investments in the Republic of Ireland or another country? If yes, please state: Name of company: Number of shares held: Yes € Their value: No , Please attach a statement to show details and current market value 25 Do you own, share in the ownership, work or rent a farm or land? Yes No If yes, please state: Size of farm or land: hectares Net yearly income: , € Net yearly income is money you have made from the farm after deducting operating expenses 26 If you have any other income, please give details in the space provided: 27 If you have not applied within three months of becoming eligible, please give reasons why: Your payment details Part Post Office Please enter below the name and address of the post office where you wish to collect your payment Post office name and address: County Eircode Page Part Details of your children 28 Do you wish to claim for children who normally live with you and who are being supported by you? Number of children age 7-13 inclusive age 18 - 22 in full-time education Please state child’s: Child Surname: First names: PPS Number: Date of birth: D D M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y Child Surname: First names: PPS Number: Date of birth: D D Child Surname: First names: PPS Number: Date of birth: D D Child Surname: First names: PPS Number: Date of birth: D D Note: A separate sheet of paper can be used for other children you wish to claim for You must attach written confirmation from the school or college for the children between 18 and 22 years of age Page 10 Details of your spouse, civil partner, former cohabitant or other parent of your child Part 29 Their PPS Number: 30 Their title, insert an X or specify: Mr Mrs Ms Other 31 Their surname: 32 Their first names: 33 Their date of birth: D D M M Y Y Y Y 34 Their address: County Eircode 35 Is the other parent of your child in employment, on a Community Employment Scheme or Employment Programme or on a SOLAS course? If yes, please state: Yes No Their employers name: Their employers address: County Eircode Their gross weekly pay: € , Gross Pay is your pay before tax, PRSI, union dues or other deductions 36 If the other parent of your child is self-employed, please state: Their occupation: Their gross weekly pay: € , Please attach their most recent set of certified accounts 37 If they are getting any payment from this department, please state: Name of payment: Weekly amount: € , Page 11 Part Habitual Residence Condition This part must be completed by all applicants Habitual residence is a condition that you must satisfy to qualify for Jobseeker’s Transitional Payment For more information, visit www.gov.ie/jst 38 What country were you born in? 39 What is your nationality? 40 When did you come to live in the Republic of Ireland? D D M M Y Y Y Y 41 Have you lived in the *Common Travel Area all of your life including the last years? Yes No If no, please complete questions 42 to 45 If yes, please give details of where you lived Country Country: From: To: D D M M Y Y Y Y M M Y Y Y Y Why did you live there? Country Country: From: To: D D Why did you live there? Page 12 Part continued Habitual Residence Condition Country Country: From: To: D D M M Y Y Y Y Why did you live there? Note *The Common Travel Area is Ireland, Great Britain, the Isle of Man and the Channel Islands You can spend brief periods on short holidays, studying or travelling outside the Common Travel Area and still be habitually resident here If you lived in Northern Ireland, Great Britain, the Isle of Man or the Channel Islands, please provide proof of residence Residency may be verified by producing a passport or identity card and one or more of the following: bank statements; details of benefit payments; utility bills; rent or mortgage agreements or receipts for local authority charges 42 Have you lived at the same address for the last two years? Yes No If no, please give details of where you lived: Last address: County Eircode From: To: D D M M Y Y Y Y D D M M Y Y Y Y Previous address: County Eircode From: To: Page 13 Part continued Habitual Residence Condition 43 Have you lived continuously in Ireland since the day you arrived? Yes No 44 Does any of your close family live in Ireland? For example, parent, brother, sister or child If yes, please give their details: Their surname: Yes No Person Their first names: Their address: County Eircode Their date of birth: D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y Their relationship to you: When they came to Ireland: Person Their surname: Their first names: Their address: County Eircode Their date of birth: Their relationship to you: When they came to Ireland: Page 14 Part continued Habitual Residence Condition Person Their surname: Their first names: Their address: County Eircode Their date of birth: D D M M Y Y Y Y D D M M Y Y Y Y Their relationship to you: When they came to Ireland: Note: A separate sheet of paper can be used for more details if needed 45 Have you ever made an application for refugee status? Yes No If yes, please answer the questions below and provide copies of all relevant documentation from the Department of Justice (a) Are you awaiting a decision on an application for refugee status? Yes No (b) Have you been granted refugee status or leave to remain in the state? Yes No (c) Do you have an Irish Residence Permit Card? Yes No If yes, please attach a verified copy of same, your local Intreo Centre or your local Social Welfare Branch Office can photocopy it for you and verify that they saw the original For official Department use only HRC satisfied HRC not satisfied HRC1 issued Page 15 Part Checklist Have you enclosed the following? — Letter from school or college if you have children aged between 18 and 22 who are in full-time education — Your children’s birth certificates if applying for an increase for them Note: No birth certificate is needed if you are already getting Child Benefit for the child — Bank statement and statements from accountant if self-employed — Tax deduction card or three recent payslips — Proof of mortgage payments or recent rent receipts — Maintenance summons/order — Separation agreement — Divorce decree, decree absolute — Decree of dissolution of civil partnership or civil union certificate If you were born, married or entered into a civil partnership or civil union outside the Republic of Ireland: — Your original birth certificate — Your original marriage certificate or a civil partnership or civil union certificate — Divorce decree, decree absolute — Your late spouse’s, civil partner’s or cohabitant’s original death certificate, a Coroner’s report is also acceptable Original certificates only Please remember to sign the Declaration in Part If you have any difficulty in filling in this form, please contact your local Intreo Centre or Social Welfare Branch Office or any Citizens Information Centre Send this completed application form to: Your local Intreo Centre or your local Social Welfare Branch Office For contact details, visit www.gov.ie/intreo Important: If you not apply within months of becoming eligible you may lose some payment Data Protection Statement The Department of Social Protection administers Ireland’s social protection system Customers are required to provide personal data to determine eligibility for relevant payments and benefits Personal data may be exchanged with other government departments and agencies where provided for by law Our data protection policy is available at www.gov.ie/dsp/privacystatement or in hard copy Explanations and terms used in this form are intended as a guide only and are not a legal interpretation 00K 09- 21 Edition: September 2021